title: Impact of pre-transplant liver hemodynamics and portal reconstruction techniques on post-transplant portal vein complications in pediatric liver transplantation: a retrospective analysis in 197 recipients.
abstract: OBJECTIVE
  Portal vein (PV) complications are the most frequent vascular complications in pediatric liver transplant (LT). We hypothesized that pre-LT liver hemodynamic parameters and PV reconstruction technique could predict the risk of PV complications post-LT.
  
  
  METHODS
  Three hundred seventy-three children had a primary LT. A detailed ultrasound study of the pre-LT native liver hemodynamics was available in 198 cases, with details of PV anastomosis available for 197 of these: end-to-end anastomosis (n = 146, 74%), interposition vein graft technique (n = 28, 14%), or portoplasty (latero-lateral anastomosis of vein graft and recipient PV) (n = 23, 12%).
  
  
  RESULTS
  Overall 5-year patient survival rate was 90%. Among the 198 patients with pre-LT hemodynamic data, 79 (40%) had PV hypoplasia (diameter ≤4 mm), 64 (32%) had a pathological portal flow (nonhepatopetal flow), and 47 (24%) had an arterial resistance index (ARI) ≥1. Abnormal hemodynamics were mostly observed in biliary atresia (BA). Among these 3 parameters, only ARI ≥1 was significantly correlated with a higher rate of PV complications post-LT (P = 0.041). PV complication-free survival at 5 years were 91% for end-to-end anastomosis, 91% for portoplasty, and 62% for interposition vein graft technique (P = 0.002). At multivariate analysis, the use of an interposition vein graft was the only factor to be significantly associated with a higher rate of PV complications post-LT (P = 0.003).
  
  
  CONCLUSIONS
  PV hypoplasia with liver hemodynamic disturbances was mainly observed in BA. Hepatic ARI ≥1 might be a good predictor of PV complications post-LT. Latero-lateral portoplasty seemed to provide the best results when end-to-end anastomosis is not feasible.
authors.affiliation: Pediatric Surgery and Transplant Unit, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium. catherine.demagnee@uclouvain.be
authors.forename: Catherine
authors.initials: C
authors.lastname: de Magnée
authors.forename: Christophe
authors.initials: C
authors.lastname: Bourdeaux
authors.forename: Florence
authors.initials: F
authors.lastname: De Dobbeleer
authors.forename: Magdalena
authors.initials: M
authors.lastname: Janssen
authors.forename: Renaud
authors.initials: R
authors.lastname: Menten
authors.forename: Philippe
authors.initials: P
authors.lastname: Clapuyt
authors.forename: Raymond
authors.initials: R
authors.lastname: Reding
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000209:etiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods